Endoscopically assisted in situ lower extremity bypass graft: A preliminary report of a new minimally invasive technique

William D. Suggs, Luis A. Sanchez, David Woo, Evan C. Lipsitz, Takao Ohki, Frank J. Veith

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: Lower extremity arterial reconstructions with in situ greater saphenous vein (GSV) are an important component of limb salvage surgery. Initially, the procedure was performed through continuous skin incisions for side branch occlusion and valve lysis with a wound complication rate of 5% to 25%. To decrease these complications, we used endoscopic GSV harvest equipment in 25 in situ vein bypass grafts in 25 patients performed over 24 months. Methods: The procedures were performed with three skin incisions: two for arterial access and a 2-cm incision above the knee to insert the Endopath device (Ethicon) to locate and clip the GSV side branches. After completion of the proximal anastomosis, the valves were lysed through the distal end of the vein with a flexible valvulotome. Completion cineangiography was performed to confirm side branch occlusion and evaluate the entire reconstruction. The results of this technique were compared with our last 25 in situ bypass grafts done with standard long incisions. Results: In the endoscopic group there was one (4%) minor wound complication (cellulitis). No postoperative arteriovenous fistulas were detected by means of duplex examination, and the average hospital stay was 6.2 ± 1 days. One graft closed at 9 months as a result of distal vein hyperplasia, but the other grafts have remained patent, with follow-up from 6 to 30 months (mean, 18 months). Patients with the standard in situ bypass grafts had significantly (P < .05) more wound complications (20%) and longer average hospital stay (9.2 ± 2 days) than the endoscopic group. Patency rates were comparable for both groups. Conclusion: These results show that less invasive endoscopic in situ bypass grafting minimizes wound complications and reduces the need for hospitalization without decreasing patency or increasing operative time.

Original languageEnglish (US)
Pages (from-to)668-672
Number of pages5
JournalJournal of Vascular Surgery
Volume34
Issue number4
DOIs
StatePublished - Oct 2001

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Lower Extremity
Transplants
Saphenous Vein
Veins
Wounds and Injuries
Length of Stay
Cineangiography
Equipment and Supplies
Skin
Limb Salvage
Cellulitis
Arteriovenous Fistula
Operative Time
Surgical Instruments
Hyperplasia
Knee
Hospitalization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Endoscopically assisted in situ lower extremity bypass graft : A preliminary report of a new minimally invasive technique. / Suggs, William D.; Sanchez, Luis A.; Woo, David; Lipsitz, Evan C.; Ohki, Takao; Veith, Frank J.

In: Journal of Vascular Surgery, Vol. 34, No. 4, 10.2001, p. 668-672.

Research output: Contribution to journalArticle

Suggs, William D. ; Sanchez, Luis A. ; Woo, David ; Lipsitz, Evan C. ; Ohki, Takao ; Veith, Frank J. / Endoscopically assisted in situ lower extremity bypass graft : A preliminary report of a new minimally invasive technique. In: Journal of Vascular Surgery. 2001 ; Vol. 34, No. 4. pp. 668-672.
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abstract = "Objective: Lower extremity arterial reconstructions with in situ greater saphenous vein (GSV) are an important component of limb salvage surgery. Initially, the procedure was performed through continuous skin incisions for side branch occlusion and valve lysis with a wound complication rate of 5{\%} to 25{\%}. To decrease these complications, we used endoscopic GSV harvest equipment in 25 in situ vein bypass grafts in 25 patients performed over 24 months. Methods: The procedures were performed with three skin incisions: two for arterial access and a 2-cm incision above the knee to insert the Endopath device (Ethicon) to locate and clip the GSV side branches. After completion of the proximal anastomosis, the valves were lysed through the distal end of the vein with a flexible valvulotome. Completion cineangiography was performed to confirm side branch occlusion and evaluate the entire reconstruction. The results of this technique were compared with our last 25 in situ bypass grafts done with standard long incisions. Results: In the endoscopic group there was one (4{\%}) minor wound complication (cellulitis). No postoperative arteriovenous fistulas were detected by means of duplex examination, and the average hospital stay was 6.2 ± 1 days. One graft closed at 9 months as a result of distal vein hyperplasia, but the other grafts have remained patent, with follow-up from 6 to 30 months (mean, 18 months). Patients with the standard in situ bypass grafts had significantly (P < .05) more wound complications (20{\%}) and longer average hospital stay (9.2 ± 2 days) than the endoscopic group. Patency rates were comparable for both groups. Conclusion: These results show that less invasive endoscopic in situ bypass grafting minimizes wound complications and reduces the need for hospitalization without decreasing patency or increasing operative time.",
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